The first case of drug-induced pseudoscleroderma and eczema craquelé related to nab-paclitaxel pancreatic adenocarcinoma treatment

We report a case of drug-induced pseudoscleroderma and eczema craquelé after treatment with nab-paclitaxel for metastatic pancreatic ductal adenocarcinoma. This case report is, according to our knowledge, the first to link solvent-free paclitaxel with pseudoscleroderma and eczema craquelé.
A 68-year-old patient with pancreatic ductal adenocarcinoma (the patient underwent total pancreatectomy 42 months ago, followed by chemotherapy with gemcitabine for 6 months) was admitted to the Department of Dermatology, Venereology and Allergology for further diagnosis of skin lesions. The skin lesions clinically appeared as extensive sclerosis distributed on the feet, especially the dorsal part (Figure 1 A), legs (Figure 1 B), knees and inner thigh area (Figure 1 C). They had progressed over the course of 10 months. Keratinization and eczema craquelé-like lesions (Figure 1 B) were observed locally. Slight skin burning sensation, skin tension, pain and limitation of the ankle and metatarsophalangeal joint movement accompanied skin lesions. Moreover, the left hand remained swollen for several months. Physical examination revealed hyperpigmentation of the skin all over the body and cachexia. The patient was diagnosed with diabetes 10 years ago. The patient remains under the care of the Regional Oncology Center, where she is undergoing treatment with nab-paclitaxel and gemcitabine, due to pancreatic cancer with lymph node metastasis confirmed by fine-needle aspiration biopsy and imaging studies.
The first skin lesions in the form of redness and swelling had developed initially over the lower extremities and then as generalized hyperpigmentation disseminated across the body, which occurred 2 months after the first administration of the current nab-paclitaxel and gemcitabine chemotherapy (treatment had been continued for 12 months; 36 rounds of the drug had already been given). Over time the skin of the lower extremities became hard. Induration of the skin proceeded from the feet to the thighs. Raynaud’s phenomenon did not occur. Doppler ultrasound of lower limb veins and arteries was within normal limits.
Basic laboratory and microbiological examinations were performed in the Dermatology Clinic. Laboratory investigations revealed microcytic anemia (a hemoglobin (Hb) level of 9.7 g/dl; a hematocrit level of 31.6%; MCV 75.6 fl); leukopenia (total leukocyte count of 3.69 × 10–9/l), hypoalbuminemia (serum albumin count of 29 g/l). Laboratory examinations...


View full text...